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MCOs concerned about federal MLR as Florida
implements CMS' requirements

InsideHealthPolicy.com
Insurers are expressing concern that CMS' medical loss ratio requirements for Florida's Medicaid managed care waiver, which went into effect April 1 for the demonstration, indicate HHS could create a federal MLR requirement for managed care organizations, despite stakeholders' arguments that existing federal requirements render MLR requirements unnecessary for Medicaid plans.
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New survey offers 1st data on managed care shift
California Healthline
A survey revealed strengths and weaknesses in California's 2011 transition of about 172,000 seniors and persons with disabilities into Medi-Cal managed care plans. Two-thirds of the responding beneficiaries said their care was the same or better than it had been before the transition, but the survey raised concerns on several fronts, most notably a lower level of notification and communication, according to Carrie Graham, assistant director of research at Health Research for Action at UC-Berkeley School of Public Health.
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CMS webinar — 'Quality Improvement 101: Developing Aims and Selecting Change Strategies' | April 5 | 2 p.m. EST
Center for Medicaid and CHIP Services
The Center for Medicaid and CHIP Services invites you to the second in a series of three Quality Improvement webinars designed to help state representatives build their capacity to develop and apply QI strategies in their Medicaid and CHIP programs. Participants will learn how to put into practice the first two questions of the Model for Improvement:
  • What are you trying to accomplish?
  • What changes are likely to lead to improvement?
Participants will look more in-depth at the driver diagram as a tool for conceptualizing the drivers of system change. Processes to identify and assess promising change strategies will also be discussed. State Medicaid and CHIP staff interested in learning how to start or enhance ongoing quality improvement projects will benefit from this session. Continuing Medical Education credit may be available to participants. To register, click here. Email here for questions about the event.

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CMS clarifies state matching funds for newly eligible in Medicaid
InsideHealthPolicy.com
CMS on March 29 clarified that a state that expanded Medicaid coverage to certain low-income adults prior to the enactment of the Affordable Care Act can still get the ACA's 100 percent federal match rate for newly eligible adults and can receive an "expansion state" FMAP that would apply to childless adults the state already covers who don't qualify as newly eligible.
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HHS: States need waiver to privatize Medicaid expansion
The Hill
States that want to privatize the healthcare law's Medicaid expansion will need a waiver from the federal government, the Health and Human Services Department said. The option of a private expansion has gained traction since Arkansas Gov. Mike Beebe first proposed it in February.
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Oregon shows costs of putting Medicaid enrollees in private coverage
Kaiser Health News
The Arkansas plan to expand Medicaid by paying for enrollees to buy private health insurance has been billed as a new option for states led by Republicans who are leery of the federal health overhaul — and it's getting attention from Republican leaders in Florida and Ohio, among other states.
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93,000 fewer kids in Pennsylvania enrolled in CHIP under Corbett
The Philadelphia Inquirer
For years, the Philadelphia region has been among the best places for a child to get sick. Pennsylvania's Children's Health Insurance Program, dating to 1992, was a model for what Congress expanded to all the states five years later. New Jersey set one of the easiest income thresholds for SCHIP and has aggressively enrolled children into Medicaid as well.
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Georgia state agency board OKs hospital provider fee
Georgia Health News
The board of the state of Georgia's Medicaid agency gave initial approval to the hospital provider fee mechanism, paving the way for renewal of the current formula in July. The next step is for the Department of Community Health to submit the proposal to federal officials, who have 90 days to approve it.
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Federal government slashes New York's Medicaid payments
Reuters
Federal authorities have dramatically lowered the amount that New York state can claim from the federal government for certain medical services, costing the state an estimated $1.2 billion. CMS cut the per-patient reimbursement rate for patients in developmental centers to $1,200 from $5,100 from April 1, according to CMS documents seen by Reuters.
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House panel OKs Medicaid expansion through HIP plan in Indiana
Indianapolis Business Journal
Medicaid would be expanded in Indiana through a state-run program under legislation approved by a House committee, but while the plan keeps an opt-out provision should federal aid ever dry up, it reverses the governor's preferred funding mechanism.
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Texas governor doubles down against Obamacare's Medicaid expansion
The Hill
Texas Gov. Rick Perry doubled down in his opposition to expanding Medicaid under President Barack Obama's healthcare law, even though opposing it could cost his state $90 billion. At a press conference where he was flanked by other conservatives, Perry argued expanding the health insurance program for the poor would make Texas "hostage" to the federal government.
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Feds like Florida plan, but some officials don't want feds' money
Health News Florida
Those who are tracking the debate on Florida Medicaid expansion may have missed three important events, and the federal government has released the official rules that say it will cover 100 percent of the cost of expansion for the joint federal-state insurance program for the poor for three years, tapering to 90 percent by 2020.
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Vote set on plan to change Medicaid in Missouri
St. Louis Beacon
The Missouri House has passed a new state budget without Gov. Jay Nixon's sought-after Medicaid expansion, but that doesn't mean Republicans are dropping the issue entirely. The House Government Oversight and Accountability Committee is slated to vote on HB700, a bill proposed by state Rep. Jay Barnes to change the state's current Medicaid program dramatically.
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WellCare wraps up Missouri Care deal
Tampa Bay Business Journal
WellCare Health Plans Inc. has up to 100,000 more members after completing the acquisition of Missouri Care Inc. WellCare did not say how much it paid to buy Missouri Care, which was a subsidiary of Aetna Inc., in a statement announcing completion of the deal.
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Federal MLR concern as Florida implements
CMS' requirements

InsideHealthPolicy.com
Insurers are expressing concern that CMS' medical loss ratio requirements for Florida's Medicaid managed care waiver, which went into effect April 1 for the demonstration, indicate HHS could create a federal MLR requirement for managed care organizations, despite stakeholders' arguments that existing federal requirements render MLR requirements unnecessary for Medicaid plans.

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Republicans' 'no' on Medicaid expansion possibly shifting
The Associated Press via
The Washington Post

Given the choice of whether to expand Medicaid under President Barack Obama's healthcare law, many Republican governors and lawmakers initially responded with an emphatic "no." Now they are increasingly hedging their objections.

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3 firms picked for DC Medicaid contracts
The Washington Post
City officials in Washington, D.C. have chosen three firms to receive some of the city's largest contracts in an effort to provide healthcare to low-income D.C. residents enrolled in Medicaid and other government health programs.

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'NICU Costs, Trends, Effective Management Solutions': A free webinar by Progeny Health | April 10 at 3 p.m. EST
MHPA
Medical costs for a baby born in the neonatal intensive care unit are considerably higher than they are for a healthy newborn. With preterm deliveries on the rise and issues with overutilization, the high costs associated with babies in the NICU are impacting payers more than ever. "NICU Costs, Trends and Effective Management Solutions" focuses on managing the care of this medically complex population. Ellen Stang, M.D., the president and CEO of ProgenyHealth, will discuss a collaborative approach to NICU care management that delivers quality outcomes and reduces costs.
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'Opioid Dependence: A Chronic Relapsing Brain Disease,' a free webinar by Reckitt Benckiser | April 17 | 3 p.m. EST
MHPA
Joe Volpicelli, M.D., executive director at the Institute of Addiction Medicine and staff physician at Chestnut Hill Hospital, will help payers, patients and their communities better understand the chronic nature of opioid dependence.
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Recent webinar presentations from Deloitte, PwC, AmeriHealth Mercy available free on MHPA's website
MHPA
View PDFs or listen to audio for "The Duals Dilemma — Identifying Effective Care Management Approaches to Support Meaningful Improvement" by Deloitte Consulting, "The Race to 2014: Health Reform and the 30 Million Newly Insured" by PwC, "Optimizing Pharmaceutical Care in a Drug Therapy Management Program" by The AmeriHealth Mercy Family of Companies and more.
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'Keeping You Healthy' video: Telemedicine program by
WellPoint / Anthem Blue Cross

YouTube
VideoBrief WellPoint State Sponsored Business is the only private health plan to develop, manage and comprehensively support a statewide Telemedicine program to improve access to care in California. Telemedicine can be used by local primary care providers to obtain second opinions on difficult cases to avoid misdiagnosis and prescribing ineffective medications. It can also significantly reduce disparities and accessibility barriers. Timely access to specialty care means early identification and treatment of conditions, resulting in better health outcomes and lower health costs. Join Michael Martineau from Anthem Blue Cross and Michelle Martin from MHPA's Center for Best Practices as they discuss this innovative program.
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2012-2013 Best Practices Compendium on sale now
MHPA
MHPA's 2012-2013 Best Practices Compendium is the sixth edition of our annual publication that contains Medicaid health plans' best practices, as well as helpful resource information. Get yours today ($25 for members, $30 for non-members). To order, call 202-857-5720, or email us.
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TRENDING ARTICLES
Missed last week's issue? See which articles your colleagues read most.

    Republicans' firm 'no' on Medicaid expansion shifting (The Associated Press via The Washington Post)
Health Partners outpaces other area plans in provider satisfaction (Health Partners)
3 firms picked for DC Medicaid contracts (The Washington Post)
California duals demo smaller than proposed, yet size concerns remain (InsideHealthPolicy.com)
Alabama legislature to take on revamp of Medicaid (The Associated Press via WBNS-TV)


Don't be left behind. Click here to see what else you missed.


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